| NPI | 1962928812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.032017) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33287) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2021-07-26 |